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1.
Front Public Health ; 9: 689765, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34395366

RESUMO

Background: Primary health care (PHC) services are underused due to the unbalanced distribution of medical resources. This is especially true in developing countries where the construction of PHC systems has begun to take effect. Social capital is one of the important factors affecting primary health care utilization. Method: This study investigated the utilization of PHC services by Chinese community residents in the past year. Social capital, PHC utilization, age, health care insurance, etc., were measured. A multilevel negative binomial model was adopted to analyze the association of social capital with PHC utilization. Results: Data of 5,471 residents from 283 communities in China were collected through a questionnaire survey in 2018. The results showed that community social capital (CSC) is significantly associated with PHC utilization in China, but individual social capital (ISC) had no significant association with PHC utilization. A one-standard deviation increase in the CSC leads to a 1.9% increase in PHC utilization. Other factors like gender, education, income, health insurance, health status, etc., are significantly associated with PHC utilization in China. Conclusions: Community social capital plays a more important role in promoting PHC utilization, while ISC plays an unclear role in PHC utilization by the residents of China.


Assuntos
Capital Social , China , Atenção à Saúde , Serviços de Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde
2.
Biomed Pharmacother ; 142: 112082, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34449307

RESUMO

RIPK1 is a protein kinase that simultaneously regulates inflammation, apoptosis, and necroptosis. It is thought that RIPK1 has separate functions through its scaffold structure and kinase domains. Moreover, different post-translational modifications in RIPK1 play distinct or even opposing roles. Under different conditions, in different cells and species, and/or upon exposure to different stimuli, infections, and substrates, RIPK1 activation can lead to diverse results. Despite continuous research, many of the conclusions that have been drawn regarding the complex interactions of RIPK1 are controversial. This review is based on an examination and analysis of recent studies on the RIPK1 structure, post-translational modifications, and activation conditions, which can affect its functions. Finally, because of the diverse functions of RIPK1 and their relevance to the pathogenesis of many diseases, we briefly introduce the roles of RIPK1 in inflammatory and autoimmune diseases and the prospects of its use in future diagnostics and treatments.

3.
Sci Total Environ ; 775: 145841, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-33621881

RESUMO

The present study examined potential effect modifiers between polycyclic aromatic hydrocarbon (PAH) exposure and the development of rheumatoid arthritis (RA) and elucidated the relationship between PAHs and RA in subgroups using data from the National Health and Nutrition Examination Survey (NHANES) (2003-2014). The relatedness between eight PAH metabolites and RA in the whole population and different subgroups was tested using multivariable logistic regression analyses. This study included 6297 participants, including 400 RA patients and 5897 non-RA control participants, with full data. Compared to the lowest quartiles, risk of RA was increased in population with the highest quartiles of 1-hydroxynaphthalene (1-NAP), 2-NAP, 2-hydroxyfluorene (2-FLU), and 3-FLU in a bias factor corrected model. The associations between urinary PAH metabolites and RA were prominent in female, young and middle-aged, obese, smoking and alcohol-consuming populations in the subgroup analysis. Our results demonstrated that PAH exposure was related to RA, and the relationship between urinary PAH metabolites and RA differed between subgroups and depended on specific PAH metabolites.


Assuntos
Artrite Reumatoide , Hidrocarbonetos Policíclicos Aromáticos , Artrite Reumatoide/epidemiologia , Biomarcadores , Feminino , Humanos , Pessoa de Meia-Idade , Inquéritos Nutricionais , Obesidade , Fumar
4.
J Am Pharm Assoc (2003) ; 61(3): 266-275, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33536155

RESUMO

OBJECTIVE: Occupational stress of health care providers may lower the quality of care. Person-environment fit theory and practical evidence have indicated that various types of knowledge and skills of health care providers are differentially associated with occupational stress. Clinical pharmacists are an indispensable part of medical teams. Clinical pharmacists in China are generally under high occupational stress, but what kind of knowledge and skills can relieve their occupational stress remains unclear. This study aimed to assess the association between the specific knowledge and skills of clinical pharmacists and their occupational stress in China. This study aimed to assess the association between the specific knowledge and skills of clinical pharmacists and their occupational stress in China. METHODS: A field questionnaire survey using a stratified sampling was conducted to gather data on occupational stress, knowledge and skills related to hospital pharmacy, and other factors of occupational stress using the Brief Job Stress Questionnaire and a self-developed instrument. Ordinary least squares regression was used to evaluate the association of the participants' knowledge, skills, and other factors with their occupational stress. RESULTS: A total of 625 clinical pharmacists from 311 tertiary hospitals in China (response rate = 84%) participated. Knowledge of or skills related to pharmaceutical care service provision (P = 0.02), the use of computers and the Internet in pharmacy practice (P = 0.02), interpersonal communication (P = 0.10), or pharmacoepidemiology (P = 0.08) was associated with reduced occupational stress of the participants. Participants who had credentials of nation-level specialized (P = 0.09) and general training (P = 0.04) for clinical pharmacist had lower degrees of occupational stress than those without these credentials. The participants' clinical professions, routine tasks, technical titles, and type of hospital they work in were also associated with their occupational stress. CONCLUSION: Enhancing several aspects of knowledge or skills among clinical pharmacists in tertiary hospitals in China may help reduce their occupational stress. Efforts are needed to improve the education and training system of clinical pharmacists in China.


Assuntos
Estresse Ocupacional , Serviço de Farmácia Hospitalar , China , Humanos , Farmacêuticos , Inquéritos e Questionários , Centros de Atenção Terciária
5.
Front Public Health ; 8: 414, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33014959

RESUMO

Background: Primary health care (PHC) is a key component of the health care system in many countries. In China, however, PHC institutions are less preferred by patients, leading to the underuse of PHC services. Factors affecting patients' preferences for PHC institutions in China remain unreported in the current literature, which was first explored in this study. Method: A qualitative interview study was conducted in Nanjing, Jiangsu Province of China. A semi-structured interview guide was applied to ask patients' opinions regarding the PHC institutions in China. Qualitative data analysis was conducted using the thematic framework approach. Results: A total of 142 participants were interviewed. Three themes and their sub-themes emerged from the study: (1) attributes of PHC services, including accessibility of primary healthcare services, consultation time, drug cost, continuity of care, referral system, opening hours, waiting time, and drug accessibility; (2) attributes of PHC doctors' workforce, including doctors' attitude, competence, and accessibility; (3) attributes of PHC facility infrastructure, including basic facilities, diagnostic facilities and department settings. It was identified that some attributes of PHC services had positive impacts on participants' preferences for PHC institutions, while the same attributes of PHC doctors were the opposite. Conclusion: There are three major factors that contribute to patients' preferences for PHC institutions in China. Policy interventions to improve doctors' workforce and facility infrastructure of PHC institutions are needed to promote patients' preferences for PHC.


Assuntos
Preferência do Paciente , Médicos , China , Humanos , Atenção Primária à Saúde , Pesquisa Qualitativa
6.
Aust J Prim Health ; 26(5): 424-430, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32900425

RESUMO

China is attempting to establish a pharmacy services network in primary healthcare (PHC) institutions. This study investigated the current status of pharmacy services in China. Following a conceptual framework derived from the structure-process-outcome model, a questionnaire was sent to a sample of 700 administrators, 2000 GPs, 2000 pharmacy service providers, 2000 patients with chronic diseases and 2000 patients receiving antibiotic transfusion treatment, selected using a multistage sampling strategy, from PHC institutions in Jiangsu Province, China, in July and August 2016. The installation of pharmaceutical facilities and devices, staffing by pharmaceutical professionals, patterns of pharmacy service provision and the outcomes of these services were assessed using descriptive statistics. There were 8346 respondents from 665 institutions (response rate 95.9%). Pharmaceutical department (63.0%), dispensary (50.2%) and pharmacy intravenous admixture services (54.1%) were not established in many PHC institutions. Dispensing (22.9%), pharmacotherapy consultation for patients (19.3%), drug management (17.4%) and prescription checking (16.5%) were the most important tasks for pharmacy service providers. Patients reported lower satisfaction with the dissemination of information regarding medication use (mean (±s.d.) 8.85±1.00%), the treatment of adverse drug reactions (5.65±0.50%), medical insurance reimbursement (15.25±2.45%) and the convenience of buying drugs (6.35±0.65%). Several issues regarding the facilities and devices related to pharmacy services, the quality and responsibilities of pharmacy service providers and the outcomes of pharmacy services may hamper the development of a pharmacy service system in PHC in China.


Assuntos
Serviços Comunitários de Farmácia/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/métodos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Criança , China , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Recursos Humanos/estatística & dados numéricos , Adulto Jovem
7.
BMC Health Serv Res ; 20(1): 715, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746808

RESUMO

BACKGROUND: It is necessary to examine doctors working with illness from a professional point of view, because it is not only related to their occupational health, but more importantly, will affect the treatment effect of patients and the overall medical level of the hospital. The purpose of this study was to explore the relationship between doctors' presenteeism and job burnout, and to identify other factors that are associated with presenteeism. METHODS: A cross-sectional survey involving doctors (except for primary doctors) was conducted in China. Using one item measure about presenteeism and a 15-item Chinese version of the BMI-GS questionnaire, this study investigated prevalence of doctors' presenteeism and job burnout, and determined the relationship between presenteeism and job burnout by logistical model. RESULTS: Relationship between presenteeism and job burnout were explored, and the influence of work factors were evaluated. The survey was completed by 1376/1547 hospital doctors, with a response rate of 88.9%. Presenteeism was reported by 30.7% of participants. Using MBI-GS, 86.8% of all doctors had moderate job burnout and 6.0%(n = 82) were severe job burnout. Logistic regression analysis showed that doctors with medium, high degree of emotional exhaustion and high degree of cynicism were more likely to practice presenteeism (all p < 0.05). In addition, two other work-related factors, including the doctors' department and position, were also likely to relate with presenteeism (all p < 0.05). CONCLUSIONS: By examining the relationship between presenteeism and job burnout, this study determined that there is indeed a significant correlation between the two. This result has a certain reference value for the development of work health, especially presenteeism and job burnout theory, and also makes a certain contribution to the relevant research literature.


Assuntos
Esgotamento Profissional/epidemiologia , Médicos/psicologia , Presenteísmo/estatística & dados numéricos , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Médicos/estatística & dados numéricos , Inquéritos e Questionários
8.
BMC Health Serv Res ; 20(1): 609, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32616033

RESUMO

BACKGROUND: This study investigated the association between presenteeism and the perceived availability of social support among hospital doctors in China. METHODS: A questionnaire was administered by doctors randomly selected from 13 hospital in Hangzhou China using stratified sampling. Logit model was used for data analysis. RESULTS: The overall response rate was 88.16%. Among hospital doctors, for each unit increase of the perceived availability of social support, the prevalence of presenteeism was decreased by 8.3% (OR = 0.91, P = 0.000). In particular, if the doctors perceived availability of appraisal support, belonging support and tangible support as sufficient, the act of presenteeism was reduced by 20.2% (OR = 0.806, P = 0.000) 20.4% (OR = 0.803, P = 0.000) and 21.0% (OR = 0.799, P = 0.000) respectively with statistical differences. CONCLUSION: In China, appraisal support, belonging support and tangible support, compared to other social support, had a stronger negative correlation with presenteeism among hospital doctors. The benefits of social support in alleviating doctors' presenteeism warrant further investigation.


Assuntos
Corpo Clínico Hospitalar/psicologia , Presenteísmo/estatística & dados numéricos , Apoio Social , Adulto , China , Feminino , Pesquisa sobre Serviços de Saúde , Hospitais , Humanos , Masculino , Corpo Clínico Hospitalar/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
9.
BMC Health Serv Res ; 20(1): 487, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32487066

RESUMO

BACKGROUND: Hospital clinical pharmacists have been working in many countries for many years and clinical pharmaceutical care have a positive effect on the recovery of patients. In order to evaluate the clinical effectiveness and economic outcomes of clinical pharmaceutical care, relevant clinical trial studies were reviewed and analysed. METHODS: Two researchers searched literatures published from January 1992 to October 2019, and screened them by keywords like pharmaceutical care, pharmaceutical services, pharmacist interventions, outcomes, effects, impact, etc. Then, duplicate literatures were removed and the titles, abstracts and texts were read to screen literatures according to inclusion and exclusion criteria. Key data in the literature were extracted, and Meta-analysis was conducted using the literature with common outcome indicators. RESULTS: A total of 3299 articles were retrieved, and 42 studies were finally included. Twelve of them were used for meta-analysis. Among the 42 studies included, the main results of pharmaceutical care showed positive effects, 36 experimental groups were significantly better than the control group, and the remaining 6 studies showed mixed or no effects. Meta-analysis showed that clinical pharmacists had significant effects on reducing systolic blood pressure and diastolic blood pressure and shortening hospitalization days (P < 0.05), but no statistical significance in reducing medical costs (P > 0.05). CONCLUSION: Clinical pharmacists' pharmaceutical care has a significant positive effect on patients' clinical effects, but has no significant economic effect.


Assuntos
Assistência Farmacêutica/economia , Assistência Farmacêutica/normas , Serviço de Farmácia Hospitalar , Resultado do Tratamento , Atenção à Saúde , Feminino , Humanos , Masculino , Farmacêuticos , Papel Profissional
10.
Qual Manag Health Care ; 29(3): 158-163, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32590491

RESUMO

BACKGROUND: With the aging population and increasing prevalence of chronic disease, the number of primary health care physicians in China is inadequate and physicians' turnover intention is too high. OBJECTIVE: To analyze the status of primary health care physicians' turnover intention in China and the relationship between physicians' perceived overqualification and their turnover intention. METHODS: With multistage stratified sampling, we randomly selected 1456 primary health care physicians as study subjects. Information on personal characteristics, job satisfaction, working pressure, turnover intention, and perceived overqualification was collected. The data were analyzed using descriptive statistics and multiple regression analysis. RESULTS: We found that primary health care physicians in China have high turnover intention and perceived overqualification is positively related to turnover intention. CONCLUSION: Government and primary health care may address perceived overqualification to reduce physicians' turnover intention.


Assuntos
Atitude do Pessoal de Saúde , Esgotamento Profissional/psicologia , Satisfação no Emprego , Reorganização de Recursos Humanos/estatística & dados numéricos , Médicos/psicologia , Atenção Primária à Saúde , Competência Profissional , Adulto , China , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Int J Clin Pharm ; 42(3): 879-886, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32405715

RESUMO

Background Due to the drug-centred tradition of Chinese hospital pharmacy and the lack of corresponding laws and regulations, Chinese clinical pharmacists may experience the problems of role ambiguity and role conflict. These problems may affect whether clinical pharmacists undertake their responsibilities, thus affecting the level of clinical pharmacy care. Objective To evaluate the level of Chinese clinical pharmacists' role ambiguity and role conflict and to analyse their influence on the undertaking of responsibilities. Setting Research was conducted in 31 provinces (autonomous regions) and municipality directly under the Central Government in mainland China. Main outcome measure Chinese version of a role ambiguity and role conflict scale was used to measure clinical pharmacists' role ambiguity and role conflict. A scale for clinical pharmacists' responsibilities was established to measure whether clinical pharmacists undertake their responsibilities. Methods Subgroup analysis and logistic regression were employed to analyse the phenomenon of Chinese clinical pharmacists' role ambiguity and role conflict and their influence on their fulfilment of responsibilities. Results Clinical pharmacists in China experience role ambiguity and role conflict. Clinical pharmacists in the eastern region, tertiary hospitals, and hospitals where clinical pharmacists training programs are available were less likely to experience role ambiguity and role conflict than those in the central and western regions, secondary hospitals, and hospitals where clinical pharmacists training programs are not available. Role ambiguity and role conflict have significant impacts on whether clinical pharmacists undertake certain responsibilities. Conclusion This study shows that clinical pharmacists in China experience problems with role ambiguity and role conflict and it will affect their fulfilment of their responsibilities. We propose that corresponding policies and measures should be taken to alleviate role ambiguity and role conflict and improve clinical pharmacy service.


Assuntos
Farmacêuticos/psicologia , Papel Profissional , Adulto , Atitude do Pessoal de Saúde , China , Feminino , Humanos , Masculino , Fatores Socioeconômicos
12.
J Med Econ ; 23(7): 760-766, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32122186

RESUMO

Aims: To identify factors influencing individuals' take-up of tax-subsidized private health insurance.Methods: A self-administered questionnaire survey was conducted to collect data in Hangzhou, China. A logistic regression analysis was applied to find factors influencing individuals' take-up of tax-subsidized private health insurance.Results: A total of 1,610 participants joined the survey, and 1,543 valid cases were obtained. The logistic regression results showed that educational level, marital status, the number of elderly people to support, types of basic medical insurance covered, disease history, reimbursement rate of outpatient visits, reimbursement rate of inpatient visits, knowledge of tax-subsidized private health insurance, and ratio of the deduction to income influenced individuals' take-up of tax-subsidized private health insurance.Limitations: Sample representativeness may be sacrificed by the fact that the data were collected from one city (Hangzhou) in a cross-sectional investigation.Conclusions: Demographic variables, such as educational level, marital status, and the number of elderly people to support, have an impact on individuals' take-up of tax-subsidized private health insurance, while age and gender are not significant. People with disease history are more likely to take out tax-subsidized private health insurance. The ratio of deduction to income is positively correlated with the take-up of tax-subsidized private health insurance. Suggestions, such as strengthening the publicity of tax-subsidized private health insurance, increasing the deduction amount, and encouraging employers to provide tax-subsidized private health insurance for employees' families are provided with the hope to promote the development of tax-subsidized private health insurance in China.


Assuntos
Cobertura do Seguro/economia , Seguro Saúde/economia , Setor Privado , Reembolso de Incentivo/economia , Impostos , Adolescente , Adulto , Idoso , China , Estudos Transversais , Técnicas de Apoio para a Decisão , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
13.
Front Cell Dev Biol ; 8: 627893, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33553167

RESUMO

Rheumatoid arthritis (RA) is a systemic autoimmune disease for which the etiology has not been fully elucidated. Previous studies have shown that the development of RA has genetic and epigenetic components. As one of the most highly abundant RNA modifications, the N6-methyladenosine (m6A) modification is necessary for the biogenesis and functioning of RNA, and modification aberrancies are associated with various diseases. However, the specific functions of m6A in the cellular processes of RA remain unclear. Recent studies have revealed the relationship between m6A modification and immune cells associated with RA. Therefore, in this review, we focused on discussing the functions of m6A modification in the regulation of immune cells and immune-related bone homeostasis associated with RA. In addition, to gain a better understanding of the progress in this field of study and provide the proper direction and suggestions for further study, clinical application studies of m6A modification were also summarized.

14.
Biomed Res Int ; 2019: 8732023, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31781648

RESUMO

The biological function of human ovaries declines along with aging. To identify the underlying molecular changes during ovarian aging, pigs were used as model animals. Genome-wide DNA methylation and transcriptome-wide RNA expression analyses were performed via high-throughput sequencing of ovaries from young pigs (180 days, puberty stage of first ovulation) and old pigs (eight years, reproductive exhaustion stage). The results identified 422 different methylation regions between old and young pigs; furthermore, a total of 2,243 mRNAs, 95 microRNAs, 248 long noncoding RNAs (lncRNAs), and 116 circular RNAs (circRNAs) were differentially expressed during both developmental stages. Gene ontology analysis showed that these genes related to different methylation and expression are involved in the ovarian aging cycle. Specifically, these are involved in cell apoptosis, death effector domain binding, embryonic development, reproduction and fertilization process, ovarian cumulus expansion, and the ovulation cycle. Multigroup cooperative control relationships were also assessed, and competing endogenous RNA (ceRNA) networks were constructed in the ovarian aging cycle. These data will help to clarify ovary age-associated potential molecular changes in DNA methylation and transcriptional patterns over time.


Assuntos
Envelhecimento , Metilação de DNA , Ovário/fisiologia , Transcriptoma , Animais , Feminino , Fertilização/genética , Fertilização/fisiologia , Expressão Gênica , Perfilação da Expressão Gênica , Ontologia Genética , Redes Reguladoras de Genes , Genoma , Sequenciamento de Nucleotídeos em Larga Escala , MicroRNAs/genética , RNA Circular/genética , RNA Longo não Codificante/genética , RNA Mensageiro/genética , Reprodução/genética , Reprodução/fisiologia , Análise de Sequência de RNA , Suínos , Sequenciamento Completo do Genoma
15.
BMJ Open ; 9(7): e028844, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31366652

RESUMO

OBJECTIVES: The impact of presenteeism on doctors' health, quality of patient care and overall performance of health institutions has been reported. The study aimed to investigate the prevalence of presenteeism among doctors, the association between presenteeism and anxiety/depression, and aspects that can help alleviate presenteeism. DESIGN: A cross-sectional anonymous survey study was conducted between 2017 and 2018. SETTING: 30 hospitals in Hangzhou city, Zhejiang Province, China including 10 category 1 hospitals (20-99 beds), 10 category 2 hospitals (100-499 beds) and 10 category 3 hospitals (> 500 beds) which had the highest population coverage. PARTICIPANTS: At least 3 doctors from each department in the studied hospitals participated. Each participant received a gift worth around US$5 at completion of the survey. PRIMARY AND SECONDARY OUTCOME MEASURES: The prevalence of presenteeism and its relationship with anxiety or depression were evaluated as the primary outcomes. Secondary outcomes included the prevalence of abnormal cases of anxiety and depression. RESULTS: The survey was completed by 1153/1309 hospital doctors (response rate 88.1%). Presenteeism was reported by 66.4% of participants. Using the Hospital Anxiety and Depression Scale, 68.8% and 72.3% of participants had abnormal cases of anxiety and depression, respectively. Logistic regression analysis showed that participants with abnormal cases of anxiety, borderline cases of depression or abnormal cases of depression were more likely to practice presenteeism (all p<0.05). Other significant work-related contributing factors included: time working at the current hospital, management duty, monthly salary and ease of replacement (all p<0.05). CONCLUSION: Presenteeism was prevalent among doctors in China and the association of presenteeism with abnormal cases of anxiety or depression was significant. Considering the modifiable work-related contributing factors, appropriate measures at the healthcare institutions to support doctors' mental health, help them develop and reinforce management skills, and ensure appropriate manpower are important to alleviate presenteeism behaviour.


Assuntos
Ansiedade/epidemiologia , Depressão/epidemiologia , Doenças Profissionais/epidemiologia , Médicos/psicologia , Presenteísmo/estatística & dados numéricos , Adulto , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Escalas de Graduação Psiquiátrica , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
16.
PeerJ ; 7: e6949, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31149403

RESUMO

Background: Aging is a major risk factor for the development of many diseases, and the liver, as the most important metabolic organ, is significantly affected by aging. It has been shown that the liver weight tends to increase in rodents and decrease in humans with age. Pigs have a genomic structure, with physiological as well as biochemical features that are similar to those of humans, and have therefore been used as a valuable model for studying human diseases. The molecular mechanisms of the liver aging of large mammals on a comprehensive transcriptional level remain poorly understood. The pig is an ideal model animal to clearly and fully understand the molecular mechanism underlying human liver aging. Methods: In this study, four healthy female Yana pigs (an indigenous Chinese breed) were investigated: two young sows (180-days-old) and two old sows (8-years-old). High throughput RNA sequencing was performed to evaluate the expression profiles of messenger RNA, long non-coding RNAs, micro RNAs, and circular RNAs during the porcine liver aging process. Gene Ontology (GO) analysis was performed to investigate the biological functions of age-related genes. Results: A number of age-related genes were identified in the porcine liver. GO annotation showed that up-regulated genes were mainly related to immune response, while the down-regulated genes were mainly related to metabolism. Moreover, several lncRNAs and their target genes were also found to be differentially expressed during liver aging. In addition, the multi-group cooperative control relationships and constructed circRNA-miRNA co-expression networks were assessed during liver aging. Conclusions: Numerous age-related genes were identified and circRNA-miRNA co-expression networks that are active during porcine liver aging were constructed. These findings contribute to the understanding of the transcriptional foundations of liver aging and also provide further references that clarify human liver aging at the molecular level.

17.
Health Soc Care Community ; 27(5): e567-e587, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31225940

RESUMO

Community pharmacy services (CPS) have been shown to be positive in many disease management and patient care programs, but clinical outcomes were followed by process indicators and methodological flaws in previous researches made it difficult to prove the effectiveness of clinical outcomes of CPS. Therefore, this study attempted to review the clinical outcomes of CPS. Interventions included are provision of medication review, patient education, adherence assessment, health/lifestyle advice, physical assessment, monitoring, prescribing, or adjusting and administering therapy from community pharmacists. By searching for key words like community pharmacists, pharmaceutical services, clinical outcomes in MEDLINE and EMBASE and manually searching (up to June 2017), 1910 studies investigating the clinical outcomes of CPS were obtained. After screening the titles, abstracts and full texts for relevancy, 52 researches with controlled groups were included and assessed for methodological quality. Finally, 25 studies were selected for the meta-analysis based on their common endpoints: systolic blood pressure, diastolic blood pressure and glycosylated haemoglobin. The Cochrane tool was used to assess the risk of bias. Chi-square and I-square tests were performed to assess heterogeneity, and the weighted mean differences were estimated using random effect models. Of the 52 articles, 47 studies demonstrated that CPS had positive clinical outcomes, 3 studies showed mixed outcomes and 2 studies revealed no effects. In the meta-analysis, intervention groups displayed greater reductions in systolic BP (95% CI: -8.198-2.356), diastolic BP (95% CI: -3.648-0.645) and HbA1c (95% CI: -0.905-0.224) than usual care groups. CPS have positive clinical outcomes, particularly significant reductions in systolic BP, diastolic BP and HbA1c. It was difficult to find out which intervention(s) of CPS directly led to certain changes and influence of CPS might be underestimated for only three common surrogate endpoints. More researches should be conducted with sufficient data.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Hipertensão/terapia , Farmacêuticos/normas , Papel Profissional , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea , Gerenciamento Clínico , Humanos , Educação de Pacientes como Assunto/organização & administração
18.
Int J Clin Pharm ; 41(2): 478-487, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30864081

RESUMO

Background Whether Chinese community pharmacists in chain pharmacies and independent pharmacies provide the same type and quality of pharmaceutical care has not been fully investigated. Objective This study aimed to investigate community pharmacists' understanding, attitude, practice and perceived barriers of pharmaceutical care at chain pharmacies and independent pharmacies in China. Setting Community pharmacies in China. Method A questionnaire survey was conducted in 27 provinces (autonomous regions) and 4 municipality cities in China. Main outcome measure Chinese community pharmacists' understanding, attitude, practice and perceived barriers of pharmaceutical care. Results The respondent pharmacists' understanding of pharmaceutical care was only moderate, though they showed a positive attitude towards providing the service. The respondent pharmacists from both chain and independent pharmacies provided more basic pharmaceutical service than advanced pharmaceutical care. Regarding barriers to providing pharmaceutical care, the respondent pharmacists identified the main barriers as a lack of physical space, slow introduction of pharmacist law, lack of patient acceptance of pharmaceutical care, and lack of face-to-face communication with patients. Pharmacists at chain pharmacies had a better understanding of and attitude toward pharmaceutical care and practiced more advanced pharmaceutical care than pharmacists at independent pharmacies. Conclusion Chinese community pharmacists' understanding and practice of pharmaceutical care in China needs improvement. Compared with pharmacists at chain pharmacies, pharmacists at independent pharmacies face more challenges in providing pharmaceutical care. Specific efforts should be made to improve pharmacist competence, increase patient acceptance and shape a better operative environment for community pharmacies, especially for independent pharmacies.


Assuntos
Atitude do Pessoal de Saúde , Serviços Comunitários de Farmácia , Farmacêuticos/psicologia , Papel Profissional , Adulto , China , Feminino , Humanos , Masculino , Inquéritos e Questionários , Adulto Jovem
19.
Gene ; 693: 1-9, 2019 Apr 20.
Artigo em Inglês | MEDLINE | ID: mdl-30695714

RESUMO

The brain as an important organ can be affected largely by aging, and the comprehensive transcriptional underpinnings of brain aging remain poorly understood. Here, we performed a high throughput RNA sequencing to evaluate the expression profiles of messenger RNA (mRNA), long non-coding RNAs (lncRNAs), micro RNAs (miRNAs), and circular RNAs (circRNAs) in porcine brain. We have identified 714 mRNAs, 38lncRNAs, 41miRNAs, and 148circRNAs were age-related genes in the porcine cerebral cortex. The lncRNAs, miRNAs and circRNAs have effect on the age of porcine brain due to the much changes of expression level as noncoding RNAs. The up-regulated genes were significantly enriched for stress response, reproductive regulatory process, immune response and metabolic process, and the down-regulated genes were related to neurologic function, stress response and signaling pathway. The synaptic transmission pathway may be the key role in aging of porcine brain that it was co-enriched for in both differentially expressed mRNAs and lncRNAs. Moreover, some lncRNAs and their target genes were also differentially expressed during brain aging. We further assessed the multi-group cooperative control relationships and constructed circRNA-miRNA co-expression networks during brain aging. We also selected 2 mRNAs, 2 lncRNAs, 2 miRNAs, and 1 circRNAs to perform the q-PCR, and the expression patterns were highly consistent between the two methods confirming the high reproducibility and reliability of the gene expression profiling in our study. In conclusion, our findings will contribute to understand the transcriptional underpinnings of brain aging and provide a foundation for future studies on the molecular mechanisms underlying brain aging.


Assuntos
Encéfalo/metabolismo , Suínos/genética , Transcriptoma/genética , Fatores Etários , Animais , Perfilação da Expressão Gênica/métodos , Ontologia Genética , Redes Reguladoras de Genes , Sequenciamento de Nucleotídeos em Larga Escala/métodos , MicroRNAs/genética , Análise em Microsséries/métodos , RNA/genética , RNA Circular , RNA Longo não Codificante/genética , RNA Mensageiro/genética , RNA não Traduzido/genética , Análise de Sequência de RNA/métodos , Transdução de Sinais
20.
J Med Econ ; 22(1): 35-44, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30351230

RESUMO

AIMS: This study analyzed discrepancies in the quantity of medical services supplied by physicians under different payment systems for patients with different health statuses and illnesses by means of a field experiment. METHODS: Based on the laboratory experiment of Heike Hennig-Schmidt, we designed a field experiment to examine fee-for-service (FFS), capitation (CAP), and diagnosis-related group (DRG) payment systems. Medical students were replaced with 220 physicians as experimental subjects, which more closely reflected the clinical choices made by physicians in the real world. Under the three payment mechanisms, the quantity of medical services provided by physicians when they treated patients with different health statuses and illnesses were collected. Finally, relevant statistics were computed and analyzed. RESULTS: It was found that payment systems (sig. = 0.000) and patient health status (sig. = 0.000) had a stronger effect on physicians' choices regarding quantity of medical services than illness types (sig. = 0.793). Additionally, under the FFS and CAP payment systems, physicians overserved patients in good and intermediate health while underserving patients in bad health. Under the DRG payment system, physicians overserved patients in good health and underserved patients in intermediate and bad health. Correspondingly, under FFS and CAP, the proportional loss of benefits was the highest for patients in bad health and the lowest for patients in good and intermediate health; while under DRGs, patients in good and intermediate health had the largest and smallest loss of benefits, respectively. LIMITATIONS: In order to increase external effects of experiment results, we used the field experiment to replace laboratory experiment. However, the external effects still existed because of the blurring and abstraction of the parameters. CONCLUSIONS: Medical treatment cost and price affected the quantity of medical services provided by physicians. Therefore, we proposed that a mix of payment systems could address the common interests of physicians and patients, as well as influence incentives from payment systems.


Assuntos
Motivação , Padrões de Prática Médica/economia , Mecanismo de Reembolso , China , Grupos Diagnósticos Relacionados , Planos de Pagamento por Serviço Prestado , Gastos em Saúde , Nível de Saúde , Humanos , Relações Médico-Paciente , Inquéritos e Questionários
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